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rW`urTP—C ""s APPLICATION POR SANITATION PERMIT ��-�� ° (Complete in Triplicate) Permit No. ................. . ............................I....... ... This Permit Expires 1 Year From Data Issued Date issued ---...- Application is hereby made to the San Joaquin local Health District for a permit to constrict and install the work herein described. This application is made In compliance with County Orli area o. 549 and existing Rules and Regulatlons: JOB ADDRESSAOCATION ........................aNSIA TRACT .......................... Owner's Name .................... .. . .... ..... . .. .�.... ............. .................. ..... ..P one ......--.---.-................--.... Address _ /.e..- .. ....................................... . City . ..... ..----.........,...................... Contractor's Name ......... . . .... .. ........................................License # 6.47.1,:F.-3?Phone Installation will servo, Residence gApartment House E] Commercial❑Traller Court ❑ Motel Other............................................ ` q � Number of living unitss....Z. Number of bedroo s .�....Garba a Gel der _........... lot Size ..6.•%_-..X121................ Water Supply: Public System and name .......... 1� ...4d1-._ -.V<-----w.._....._..........................................Private ❑ Q , Character of soil to a depth of 3 feet: Sand D Silt❑ Clay ❑ Peat❑ Sandy loam❑ Clay loam ❑ Hardpan ❑ Adobe ` Fill Material ............If yes,type............... ............ !Piot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATIONS lNo septic tank or seepage pit permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size................................................ Liquid Depth ...... ................ . Capacity .................... Type .................... Material...................... No. Compartments .................... Distance to nearest- Well ...Foundation ...................... Prop. line i-EACHING LINE [ ] No. of lines ........................ Length of eachline............................ Total Length ............................ 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ - Distance to nearest, Well ........................ Foundation ........................ Property line ........................ SEEPAGE PIT [ Q Depth .................... Diameter .................Number ............................ Rock Filled Yes ❑ No ❑ WaterTable Depth ................................................Rock Size ................................ Distance to nearest, Well ........................................Foundation .................... Prop. Line ..........-........... REPAIRIADDITION(Prev. Sanitation Permit ................. .......... . Date ...... . ---.. .) Septic Tank f Specify Requirements) y P� - .. ... --- i7isoosai Field ;Specify Requirements) .... . .. _ .. ...... .............. .. - 41........................... . . ...........•..................... -....................................................................._............................................................................................ !Draw existing and required addition an reverse side) I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin Pounty Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or llcen- sed agents signature certifies the following: "I certify that In the performance of the work for which this permit is issued, I shall not employ any person In such manner as to beco _ s b cto Work 's Co pensatlon laws of California." n ec' • Owner By ..... ................../6cr;tlh �J' ............................ Title ........ f......................................... ........... I I f oan owner! / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - .......... DATE ..... .".a'... .. BUILDING PERMIT ISSUED .... ..................................................................................................DATE-.................................-----.... ADDITIONAL COMMENTS ...... ........ .... .... .................................... ...... ..............---.......................... ............................ .... .. ..... --- Final Inspection by: ...... ............... .. . .....................Date ..... .~. .........-------- ER 13 24 1-69 5ai SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M